By Dr. Naomi Mackle, Dermatology Specialist and Medical Director, Adare Dermatology Clinics
Azelaic acid has become one of the most talked-about ingredients on social media, often recommended as a gentle fix for everything from breakouts to redness to dark marks. It is a genuinely useful ingredient, but like most things in skincare, it works best when it is used for the right reasons, by the right person, in the right routine. Here is what you need to know.
What is azelaic acid?
Azelaic acid is a naturally occurring dicarboxylic acid, found in grains such as wheat, rye and barley and also produced by yeast that lives on normal skin. In skincare it is made synthetically and used in creams, gels and serums, typically at around 10% in over-the-counter products and 15–20% in prescription formulations.
It works in several ways at once. It has antibacterial activity against the bacteria involved in acne, it helps normalise the way skin cells shed so pores are less likely to clog, it calms inflammation, and it interferes with the enzyme that drives excess pigment production. That combination is what makes it versatile.
What does the evidence actually show?
Azelaic acid is one of the better-studied ingredients in the cosmeceutical space. The evidence is strongest in three areas:
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Acne. Prescription-strength azelaic acid has been shown in clinical trials to reduce both inflammatory spots and blackheads, with modest but meaningful results.
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Rosacea. A 15% gel is a licensed treatment for the papulopustular (bumpy, spot-prone) form of rosacea. In practice, it is most helpful in mild cases.
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Pigmentation. It can help fade the dark marks left behind after acne (post-inflammatory hyperpigmentation), and it has also been studied in melasma.
What the evidence does not show is that azelaic acid is a miracle ingredient. Its effects are real but gradual, and it tends to perform best as one part of a considered routine rather than as a standalone treatment.
Who does it suit?
Azelaic acid is a good option for people with acne-prone skin who are left with marks after breakouts, people with very mild rosacea, and those looking for a gentler alternative to stronger actives. It is also considered one of the safer active ingredients to use during pregnancy, which makes it a useful option at a time when many others are off the table. As always, let your doctor know what you are using if you are pregnant or breastfeeding.
Who should be cautious?
Although its irritancy profile is generally gentle, azelaic acid can still cause stinging, itching, burning or dryness, particularly in the first few weeks. You should take more care if:
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your skin barrier is already compromised or sensitised
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you are already using several active ingredients
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you are using a retinoid, particularly tretinoin (more on that below)
If irritation persists beyond the first couple of weeks, or is significant, stop and seek advice.
Azelaic acid and tretinoin: a combination I don't recommend
There is a lot of discussion online about layering azelaic acid with topical tretinoin. I would not recommend this. Tretinoin is a very strong ingredient that tends to irritate the skin barrier on its own. Adding azelaic acid on top of it adds further stress to a barrier that is already under pressure, and the result is often more irritation, not better skin.
If you must use the two, never apply them at the same time. Use azelaic acid in the morning and tretinoin at night. That said, in my experience many people struggle to tolerate tretinoin over the long term, and there are usually better-tolerated ways to reach the same goals.
How to introduce it safely
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Start once a day. This gives your skin time to adjust.
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Build up slowly. After about six weeks, if your skin is comfortable, you can increase to twice a day.
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Keep it apart from tretinoin. Never apply the two at the same time, at any stage.
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Wear sunscreen daily. This matters for anyone treating pigmentation.
Note: A patch test is not usually necessary for azelaic acid.
Why REFORM doesn't use azelaic acid
People often ask why REFORM Skincare doesn't include azelaic acid. The honest answer is not that it is a bad ingredient. It is a good, mild ingredient with a clear place in dermatology.
But REFORM already uses ingredients that address the same concerns. Niacinamide supports the skin barrier and helps with redness and uneven tone. Glycolic and mandelic acids improve texture, clarity and pigmentation. Our phytobotanical gel works as an anti-inflammatory to calm reactive skin. Depending on what you are treating, I believe these are likely to be the better choice.
There is also a more fundamental principle at play. You cannot layer many different products on the skin and expect a good result. More ingredients means more potential for irritation and less clarity about what is actually working. A focused routine almost always outperforms a crowded one, so we simply haven't introduced it.
The takeaway
Azelaic acid has its place, particularly for acne-induced pigmentation and very mild rosacea, but it works best as part of a considered skincare routine rather than as a solo product.
